End-Stage Kidney Disease

Written by Christine DiMaria and Marijane Leonard | Published on July 18, 2012
Medically Reviewed by George Krucik, MD


A diagnosis of end-stage kidney disease means that you are in the final stage of kidney disease, and your kidneys are not functioning well enough to meet the needs of daily life. Your kidneys are responsible for filtering waste and excess water from the blood in the form of urine.

If you have end-stage kidney disease, also referred to as end-stage renal disease (ESRD), your kidneys are functioning below 10 percent of their normal function. This may mean that your kidneys are barely functioning or not functioning at all. Kidney disease is usually progressive. It typically does not reach the end stage until 10 to 20 years after you are diagnosed with chronic kidney disease, which may also develop slowly.

What Causes End-Stage Kidney Disease?

Many types of kidney diseases attack the nephrons—the tiny units in the kidneys that actually do the filtering. The result is blood not being filtered properly and, eventually, ESRD. Diabetes and hypertension (high blood pressure) are the two most common causes of ESRD. Diabetics cannot break down glucose (sugar) correctly, and levels remain high in the blood. High levels of glucose in the blood damage the glomeruli in the nephrons. If you have hypertension, the increased pressure that is forced upon the small vessels in the kidneys leads to damage that makes the vessels unable to perform their blood-filtering duties.

Who Is at Risk for End-Stage Kidney Disease?

The two main groups at risk for ESRD are diabetics and those with hypertension. You are also more likely to develop the condition if you have relatives with the disease.

Your risk of developing ESRD also rises when you have any type of kidney disease or condition, including:

  • polycystic kidney disease
  • Alport syndrome
  • interstitial nephritis
  • pyelonephritis
  • certain autoimmune conditions, such as lupus

What Are the Symptoms of End-Stage Kidney Disease?

You may experience a wide range of symptoms including:

  • a decrease in urine output
  • inability to urinate
  • fatigue
  • general ill feeling
  • headaches
  • unexplained weight loss
  • loss of appetite
  • nausea and vomiting
  • dry skin and itching
  • changes in skin color
  • bone pain
  • confusion and difficulty concentrating

Other symptoms may include:

  • bruising easily, along with frequent nosebleeds
  • numbness in hands and feet
  • bad breath
  • excessive thirst
  • frequent hiccups
  • absence of menstrual cycles
  • sleeping problems such as obstructive sleep apnea and restless leg syndrome (RLS)
  • low libido or impotence
  • swelling (edema), especially in the legs and hands

How Is End-Stage Kidney Disease Diagnosed?

Your physician will diagnose ESRD through a physical examination and blood tests to check kidney function.

How Is End-Stage Kidney Disease Treated?

End-stage kidney disease has two treatments: dialysis or kidney transplant.


When you undergo dialysis, there are two options. One is hemodialysis, which is a process that uses a machine to process your blood. It then filters out the waste using a solution, and then it places the clean blood back into your body. This treatment method is usually used three times per week, and it lasts three to four hours each time. Your physician may also prescribe peritoneal dialysis—a treatment that consists of a solution being inserted into your abdomen that is later removed using a catheter.

Kidney Transplant

Kidney transplant surgery involves removing your diseased kidneys and replacing them with a donated organ. One healthy kidney is all you need. This means that donors are often living because they can donate one and continue to function normally. Kidney transplants are among the most-common transplant surgeries in the U.S.

Other Management Techniques

Diabetics and those with hypertension must control their conditions. Both conditions benefit from drug therapy using angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs).

A diet low in sodium, potassium, and other electrolytes may be needed, along with fluid restrictions. Caloric intake may need to be increased, and protein consumption may need to decrease.

Complications of End-Stage Kidney Disease

Possible complications of ESRD include the following:

  • skin infections from itching and dry skin
  • hepatitis B, hepatitis C, and/or liver failure
  • heart and blood vessel problems
  • fluid buildup around the lungs
  • hyperparathyroidism
  • increased risk of infections
  • malnutrition
  • nerve damage
  • joint, bone, and muscle pain
  • anemia
  • stomach and intestinal bleeding
  • brain dysfunction and dementia
  • abnormal electrolyte levels
  • blood glucose level changes
  • seizures
  • weakening of the bones, joint disorders, and fractures

Long-Term Outlook for End-Stage Kidney Disease

A diagnosis of ESRD used to be an automatic death sentence; however, advancements in treatments allow patients to live much longer than ever before. Without dialysis or a kidney transplant, death will occur. The outcome of the treatment depends on the patient.

Preventing End-Stage Kidney Disease

In some cases, end-stage kidney disease is not preventable. However, you should keep your blood glucose levels and your blood pressure under control. Always seek medical attention if you experience any ESRD symptoms because early detection and treatment can delay or prevent progression of the disease.

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